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- Pauli, Nina, et al.
(författare)
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Exercise intervention for the treatment of trismus in head and neck cancer - a prospective two-year follow-up study.
- 2016
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Ingår i: Acta oncologica (Stockholm, Sweden). - 1651-226X. ; 55:6, s. 686-692
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Tidskriftsartikel (refereegranskat)abstract
- Background This study aims to investigate the long-term effects of structured trismus intervention in patients with head and neck cancer (HNC) and trismus in terms of mouth opening, trismus-related symptoms and health-related quality of life (HRQL). Material and methods Fifty patients with HNC to receive radiotherapy±chemotherapy were included in this prospective study along with a matched control group. The intervention group received a 10-week structured exercise with a jaw mobilizing device (TheraBite® jaw device or Engström device). Patients were assessed before and after trismus exercise intervention and at a two-year follow-up. Primary endpoint was maximum interincisal opening (MIO) and secondary endpoints included trismus-related symptoms and HRQL assessed with patient-reported outcome (PRO)-instruments [Gothenburg Trismus Questionnaire (GTQ), European Organization for Research and Treatment of Cancer Core Questionnaire (EORTC QLQ-C30) and the related HNC-specific module the EORTC Head & Neck Questionnaire (EORTC QLQ-H&N35)]. Results The intervention group had a higher MIO at the two-year follow-up compared to the control group (40.5mm and 34.3mm, respectively), which was statistically significant. The intervention group also reported less jaw-related problems according to the GTQ and higher functioning as measured by EORTC QLQ-C30 and QLQ-H&N35 compared to the control group. Conclusion A positive persistent effect of exercise intervention for trismus in HNC patients was found with regard to MIO, trismus-related symptoms and HRQL. Exercise intervention is important in long-term treatment of radiation-induced trismus in HNC patients. The trismus-specific questionnaire, GTQ, is a valuable tool for observing and evaluating trismus over time.
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| 2. |
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| 3. |
- Pauli, Nina, et al.
(författare)
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Temporomandibular disorder in head and neck cancer patients undergoing radiotherapy: Clinical findings and patient-reported symptoms
- 2019
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Ingår i: Head and Neck-Journal for the Sciences and Specialties of the Head and Neck. - : Wiley. - 1043-3074. ; 41:10, s. 3570-3576
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Tidskriftsartikel (refereegranskat)abstract
- Background The aim of this study was to investigate how common temporomandibular disorder (TMD) symptoms are among head and neck cancer (HNC) patients before and after oncological treatment. Methods Eighty-nine patients with HNC receiving radiotherapy were enrolled in the study. Patients were examined before radiotherapy and at 6 and 12 months after radiotherapy to evaluate the function and tenderness of the temporomandibular jaw and the muscles of mastication as well as the patient-reported symptoms. Results At 6 months after radiotherapy, there was a large increase in the number of patients reporting problems with opening their mouth, fatigue, stiffness, and pain of the jaw. Sixty-eight percent of the patients had symptoms of TMD before oncological treatment and 94% and 81% had symptoms at the 6- and 12-month follow-up, respectively. Conclusion The signs and symptoms of TMD escalate after radiotherapy, with symptoms peaking at 6 months after radiotherapy. Most commonly, patients suffer from restricted mouth opening, stiffness, fatigue, and pain of the jaw.
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| 4. |
- Pauli, Nina
(författare)
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Treating radiation-induced trismus in head and neck cancer;Exercise intervention and risk structures
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Abstract The overall aim of this thesis was to investigate the incidence of trismus in head and neck cancer (HNC) and to assess the treatment of radiation-induced trismus with a structured jaw exercise program using jaw mobilising devices. Furthermore the aim was to investigate anatomic risk structures related to the development of radiation-induced trismus. The patients were included at the Sahlgrenska University Hospital, Gothenburg, Sweden. In the prospective study addressing trismus incidence (n=75), results demonstrated that the incidence of trismus was 9% pre-treatment and 28% at the one-year follow-up post-treatment. Patients with trismus reported greater problems with jaw-related problems, eating limitations, dry mouth, social eating, swallowing and pain compared to HNC patients without trismus. In the two prospective intervention studies (n=100 and n=50) it was demonstrated that the structured exercise with jaw mobilising devices improved mouth opening with an average of 6.4 mm, and patients reported improvements in health-related quality of life and less trismus related symptoms compared to the control group. In the study investigating risk structures for trismus (n=216) it was demonstrated that mean doses of the masseter muscle and the temporomandibular joint were significant predictors for trismus. In conclusion, trismus is a common symptom related to the treatment of HNC and regular measurement and assessment of trismus is important. Structured jaw exercise program is recommendable for the treatment of patients with trismus. The masseter muscle may be a possible candidate for future trismus-sparing techniques.
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| 5. |
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| 6. |
- Thor, M, et al.
(författare)
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Temporal patterns of patient-reported trismus and associated mouth-opening distances in radiotherapy for head and neck cancer: A prospective cohort study.
- 2018
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Ingår i: Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery. - : Wiley. - 1749-4486. ; 43:1, s. 22-30
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Tidskriftsartikel (refereegranskat)abstract
- To identify temporal patterns of patient-reported trismus during the first year post-radiotherapy, and to study their associations with maximal interincisal opening distances (MIOs).Single institution case series.University hospital ENT clinic.One hundred and ninety-six subjects who received radiotherapy (RT) for head and neck cancer (HNC) with or without chemotherapy in 2007-2012 to a total dose of 64.6/68Gy in 38/34 fractions, respectively. All subjects were prospectively assessed for mouth-opening ability (Gothenburg Trismus Questionnaire (GTQ), European Organization for Research and Treatment of Cancer quality of life Questionnaire (EORTC QLQ-H&N35), and MIO) pre-RT and at 3, 6 and 12months after RT.Correlations between temporally robust GTQ symptoms and MIO as given by Pearson's correlation coefficients (Pr ); temporally robust GTQ-symptom domains as given by factor analysis; rates of trismus with respect to baseline by risk ratios (RRs).Four temporally robust domains were identified: Eating (3-7 symptoms), Jaw (3-7), Pain (2-5) and Quality of Life (QoL, 2-5), and included 2-3 persistent symptoms across all post-RT assessments. The median RR for a moderate/severe (>2/>3) cut-off was the highest for Jaw (3.7/3.6) and QoL (3.2/2.9). The median Pr between temporally robust symptoms and MIO post-radiotherapy was 0.25-0.35/0.34-0.43/0.24-0.31/0.34-0.50 for Eating/Jaw/Pain/QoL, respectively.Mouth-opening distances in patients with HNC post-RT can be understood in terms of associated patient-reported outcomes on trismus-related difficulties. Our data suggest that a reduction in MIO can be expected as patients communicate their mouth-opening status to interfere with private/social life, a clinical warning signal for emerging or worsening trismus as patients are being followed after RT.
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